Drug addiction is a problem that affects people across every demographic, but the individual effects of the problem can be felt very differently. Perhaps the most basic example of this is how men and women are prone to substance abuse, impacted by substance abuse, and treated for substance abuse. The crossroads of gender and addiction reveal many facets of male and female psychology, and how drugs and alcohol derive their addictive power.

Addiction and the Biology of the Genders

One of the primary starting points of the conversation of how dangerous drinking and drug abuse affect men and women in different ways is in terms of looking at biology. The journal Psychiatric Clinics of North America explains that women have less total body water than men, so they reach a higher level of blood alcohol concentrations after drinking roughly the same amount of alcohol as men. This has the effect of a woman becoming intoxicated after drinking a smaller amount of alcohol than a man. The Hepatology journal also points out that women have a lower concentration of an enzyme that metabolizes alcohol, which causes the alcohol to remain in their systems for longer periods of time, lowering the threshold for intoxication.

In the opinion of Psychiatric Times, these factors (and others) contribute to women having an “increased vulnerability […] to the consequences of drinking,” where the consequences are physiological and psychological in nature. Furthermore, when the journal Alcoholism: Clinical & Experimental Research published a study on the topic of “neuroimaging of gender differences in alcohol dependence,” researchers discovered that even when women drink less alcohol, their brains atrophy in a similar way to those of men.

Menstrual Cycles and Addiction

When talking about the key biological differences between the genders, hormones and menstrual cycles are an obvious point; but findings from clinical studies have further suggested that the effects of women’s menstrual cycles may also change how addiction works in male and female bodies. Experiments on rats have found that the estrogen hormone changes how the rats respond to cocaine, especially in the areas of the brain that are responsible for processing and anticipating pleasure and rewards. Various scientific publications, such as Psychopharmacology, the Journal of Substance Abuse Treatment and Drug & Alcohol Dependence, have used this to suggest the reason women have a greater responsiveness to cocaine and why women have a “more severe use of cocaine” when taking the drug.

In other studies, women have reported that their relative position in their menstrual cycle also affects how they feel when they take cocaine; for example, some women say that cocaine does not make them feel as high when they are in the luteal phase of their cycle (which begins after ovulation) as opposed to the follicular phase (which concludes with ovulation). Researchers writing in Experimental and Clinical Psychopharmacology posted that ovulating women could be more vulnerable to relapse during the follicular phase of their cycle, a concern that would naturally be of no significance to male users of cocaine.

Male and female hormones may have an unexpectedly big say in determining the chances of an addiction developing. In Trends in Pharmacological Sciences, researchers suggested that women are more cognizant (subconsciously or otherwise) of the rewarding effects of drugs, and it may be estrogen that is responsible for this awareness. Estrogen appears to trigger receptors for drugs within the brain; when the receptors are activated, the effects of the substances being consumed are more keenly and quickly felt, increasing the chances that a woman taking drugs will be unable to resist the temptation to experience those feelings again.

Women and Addiction

As women have been shown to be more susceptible to the effects of alcohol, the journal Biological Psychiatry reveals that neuroimaging techniques have shown that women who take cocaine show that their brains are activated to a greater degree than males. Women’s brains tend to be more active in the regions that assess the enjoyment of an experience, and that creates a link between the experience and its consequences; researchers writing in the American Journal of Psychiatry report that they found no such connection in male brains.

The focus on how chemical substances affect women is the result of the realization that the biological, psychological, and sociocultural differences between the genders has a number of effects in how men and women respond differently to addiction. In 2007, the Drug and Alcohol Dependence journal wrote that 90 percent of the articles on the topic of gender and addiction were published after 1990.

One reason for this, says The Fix, is that the gender gap has been steadily shrinking since the 1970s, because with women receiving more rights and privileges in the home and workplace,

the stigma on a woman drinking (and engaging in recreational drug consumption) is much smaller than it used to be. But now, “American women are drinking more like men,” wrote Newser in 2015, quoting a report from the National Institute of Health that found that drinking patterns among women were closer matching those among men than in the past. Women have much more access to alcohol than before, and images of women drinking are widespread in mass marketing and media – even going so far as to influence what types of alcoholic beverages female consumers drink.

Furthermore, the Journal of Psychiatric Research published a January 2013 article that found that women have a “heightened fear response” to trauma that makes women twice more susceptible to development post-traumatic stress disorder in the aftermath of a traumatic event than men. Substance abuse is a very common co-occurring disorder in people who have mental health conditions of depression and anxiety, either prompting them to self-medicate when they are going through periods of their respective mental illness or triggering a relapse when their recovery becomes a struggle.

The propensity for women to be more at risk for developing major depression, anxiety, and post-traumatic stress disorder suggests that these psychological risk factors can play significant roles in the gender and addiction balance.

Substance Abuse in the Male Brain

But the unique effects that drug and alcohol abuse has on gender are felt by men too. The National Institute on Drug Abuse writes that while less than 30 percent of college-aged women reported using marijuana, almost 40 percent of men of college age reported smoking (or otherwise consuming) the drug. Further to that point, the Journal of Adolescent Health found a connection between college-aged men drinking alcohol and abusing prescription drugs while on campus; no such association was found in young women. Similarly, researchers found that for boys, previous substance abuse was connected to “an increased likelihood of substance abuse of prescription opioids (painkillers) during young adulthood.” For girls, however, only previous marijuana use had any such connection.

In Biological Psychiatry, researchers discovered that consuming alcoholic beverages triggered a greater release of dopamine in male brains than it did in female brains. Dopamine is the neurotransmitter that the brain produces when a person does something they find pleasurable and rewarding. The purpose of dopamine is to develop an anticipation of feelings of satisfaction and reward, with the idea of the person seeking such behaviors out in the future, in order to experience those sensations again.

Dopamine is released by the brain whenever a person does something enjoyable, including moderate drinking or recreational drug abuse. Ideally, dopamine production tapers off after a point, and the behavior ceases. For some people, whether as a result of individual brain chemistry, a family history of substance abuse, mental health issues, stress, or gender, dopamine production continues, creating a dangerously strong connection between the consumption of alcohol or drugs and pleasure.

So, even though women require less alcohol to get intoxicated, alcohol tends to have a stronger effect on the brain in men than it does in women.

Gender Roles and Addiction

The stronger effect of alcohol in the male brain may also explain how some of the reasons men and women consume addictive substances fall on gender lines. In 2012, the Archives of General Psychiatry wrote that men usually take drugs or alcohol to reinforce standard ideas of gender roles. With smoking, men smoked to enjoy the physical aspects, such as the brief burst of stimulation, followed by a period of calm and relaxation. Women, on the other hand, used cigarettes more for social bonding reasons. The Journal of American College Health writes of how social smoking creates an “instant conversation starter and an immediate bond with strangers.” In writing of how young women perceive the act of cigarette smoking across different parts of their lives, Health Education Research explains that the social context of smoking (in conjunction with spending time around other smokers, drinking alcohol, and going to places where alcohol is available, like a club or a bar) was a “predominant influence” on young women, from the time they left home to the time they became mothers.

The social aspect of women and addiction also speaks to the various ways women are drawn into substance abuse. The American Journal of Drug and Alcohol Abuse writes of how women who are homemakers, who live with a spouse or partner who is a substance abuser, are at risk for picking up

the addiction; partly because, as evidence suggests, women abuse drugs for social reasons, but also because living with an addicted partner increases stress levels, decreases wellbeing and happiness, and increases access to drugs. All three factors can contribute to the development of a substance abuse problem. They can also impede recovery, since the threat of relapse will always be present.

Furthermore, a woman who lives with an addicted partner would likely be pressured to remain with her partner, regardless of the dangers she may face (even to the point of treatment being dissuaded if it entails terminating the relationship). This is especially the case if there are children involved.

While women may cease addictive behavior as they enter into the traditional gender role of child-rearing, the relationship between men and addictive substances suggests that males consume drugs or alcohol to reinforce (perceived) stereotypes for that gender, such as to have more and better sexual experiences, to live dangerously, and even to boost and improve their productivity (for example, taking Adderall to concentrate through fatigue or for work or school purposes).

Treating Addiction in Men and Women Differently

Another area of difference between the genders that also overlaps into treatment is how men and women approach the subject of seeking help. Men tend not to self-report their substance abuse, or their need of treatment; the male gender is less likely to admit to mental health problems, notes the American Psychological Association.

Women, on the other hand, are generally better at identifying problems and then taking the necessary steps to get help. Women may also be easier to convince to acknowledge a substance abuse problem, whereas a man might allow a belief in traditionally masculine ideals to even deny the existence of such a problem. This would have the effect of not only prolonging the addiction, but also adding further layers of stress, frustration, anger, and isolation on top of the preexisting mental health issues that contributed to the addiction.

Gender-based Psychological Barriers to Treatment

When it comes to treatment, the function of gender in behavior and psychology can also create its own barriers. Women tend to face an uphill climb. Researchers writing in the Journal of Substance Abuse Treatment found that women were less likely to stay in treatment for longer than 30 days when compared to men. The short duration was attributed to women being away from their families and responsibilities, to the point where the distractions and guilt they felt at being away from children and domestic obligations hampered any further progress in their therapy.

Naturally, concluding treatment prematurely carries a number of risks, as the women (or men) who take this option are not yet ready to live sober again. Returning to a home environment where there is stress, an addicted partner, access to drugs and alcohol, or a combination of all three, could present a situation tailor-made for relapse, and a resumption of addictive behavior and mental health imbalances even more damaging than the initial experience.

Men are unlikely to enter treatment programs unless they are incentivized in some way. The American Journal of Drug and Alcohol Abuse explains that men tend to perform better in treatment if they are presented with ultimatums:

The Psychology of Drug Addiction Treatment for Men and Women

The psychology of treating a drug or alcohol problem will also have to be different when applied to men and women. Treatment should address the gender-based barriers that a particular client has erected; for example, a female client’s desire for social inclusion should be examined, and a male client’s reluctance to seek help will need to be deconstructed. If there are any issues of gender that a client brings to the treatment table, a counselor should be aware of the various factors that inform whatever those issues are, in terms of upbringing, environment, and social attitudes, especially as they pertain to gender.

Other elements of the treatment process can be tailored to address gender-specific needs. Some rehabilitation centers offer onsite child care, letting mothers still be near their children, even as they receive counseling. Onsite child care also ensures children are removed from a home environment that may be host to trauma, threats to development and wellbeing, and addictive substances that can be found and abused by unsuspecting children or adolescents. Such a service is offered for women who have to enter long-term treatment programs.

Similarly, other treatment facilities have programs that cater to a specifically male clientele, to address concerns that male clients may not feel comfortable discussing in the presence of women. This may be the case if issues of sex, marital fidelity, or masculinity are at the heart of, or were affected by, the drug addiction. Group therapy sessions may be all-male, for example, or the entire rehabilitation facility may be for male clients only.

How such sessions are led may also speak to the differences between genders, and how the differences should be taken into consideration when plotting out treatment. Women’s groups tend to be based more on nurturing and comforting a client’s way to recovery; men’s groups, on the other hand, can stress the virtues of strength and masculinity (or other male-oriented attributes) as a way to cast off the burden of substance abuse.

Insights into the male and female psyches can provide valuable tools to employ during the recovery process, helping clients address their addictions and mental health issues on a level that speaks to, and complements, their identities as men and women.